COMMENTARY

Local Radiation May Improve Survival in Women With Metastatic Cervical Cancer

Maurie Markman, MD

Disclosures

September 17, 2018

Hello. I am Dr Maurie Markman from Cancer Treatment Centers of America in Philadelphia. I want to briefly discuss a very interesting paper that just appeared in JAMA Oncology, titled "Association of Definitive Pelvic Radiation Therapy With Survival Among Patients With Newly Diagnosed Metastatic Cervical Cancer."[1]

The role of radiation, and now chemoradiation, in the management of locally advanced cervical cancer is well known. The combination of these two modalities has substantially improved survival in patients with locally advanced cervical cancer.

In the setting of metastatic disease, however, we have generally believed that the primary modality should be chemotherapy because the disease has spread [and is no longer localized]. It is beyond the pelvis, beyond the area where definitive radiation could be used for cure or control.

The very interesting analysis published in JAMA Oncology raises major questions [about this practice, however]. The authors looked at the National Cancer Database from 2004 to 2014 and identified a total of 3169 patients with metastatic cervical cancer. The investigators compared patients who were reasonably well matched: those who received only chemotherapy versus the majority of patients who received pelvic chemoradiation for treatment of metastatic disease. They found a significant survival advantage associated with the use of radiation.

This was not a randomized trial, however, and clearly, the [metastatic disease may have been different in those] patients who received radiation compared with those patients who received chemotherapy alone. But the point is that local control of cervical cancer may potentially have a significant impact on survival, even in the setting of documented metastatic disease at diagnosis. This is an important analysis. I believe that, clinically, considering local control even in a setting where you know the disease [has spread] elsewhere—in the lung, for example—may have a positive impact.

I encourage you to read this paper. I believe that it should inform our thinking about management of patients newly diagnosed with this very difficult condition, metastatic cervical cancer.

Thank you for your attention.

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